StorkNet interview with
Henry Lerner, M.D., OB/GYN
MISCARRIAGE: Why It Happens and How Best to Reduce Your Risks
Lerner, M.D., OB/GYN is the author of Miscarriage:
Why It Happens And How Best To Reduce Your Risks. A graduate
of Harvard Medical School, he has been an obstetrician/gynecologist
for more than twenty years. He has appeared on "Nightline," "Larry
King Live," and "Firing Line" and has been interviewed for magazines
including Time and People. He lives in Newton, Massachusetts.
occurs in the first trimester or later in a pregnancy, a miscarriage
is always an emotionally traumatic event, sometimes a physically
daunting one, and all too often an isolating experience. Adding
to the frustration and disappointment of the 800,000 women who
miscarry every year, busy obstetricians often lack up-to-date
or specific knowledge about the causes and consequences of this
profound event. Into this fact-vacuum comes Miscarriage, a book
that every physician will confidently recommend and that women
hungry for information will seek out. From the chromosomal, illness-related,
immunological, and genetic reasons for miscarriage to the diagnostic
tests and surgical procedures now available, this authoritative
guide reflects the latest medical information on why miscarriages
do and don't happen and the best methodologies known for recovery
and preparing to conceive again.
stories from women who have miscarried and reassuring input from
a female doctor, Miscarriage also provides substantive
advice for coping with the anxiety and depression that often accompany
the loss of pregnancy.
Stop by our
and Birth cubby and read Dr. Lerner's article titled Stress
Why It Happens And How Best To Reduce Your Risks.
to Dr. Henry Lerner, author of Miscarriage: Why It Happens And How Best To Reduce Your Risks.
Dr. Lerner replied to StorkNet members' questions about miscarriage and related issues. As many of our members have experienced one or more miscarriages, we know this topic will be one of great value and support. Be sure to take a moment to read Stress in Pregnancy, written by Dr. Lerner.
I've recently suffered through my third miscarriage. My
first two were between 8-10 weeks. With my last pregnancy
I was diagnosed with a subchorionic hematoma at 8 weeks.
I had severe bleeding and my doctor gave me a 50% chance
of carrying the baby to term. I was considered high risk
and went to weekly appointments and ultrasounds. At 12 weeks
my ultrasound showed the hematoma to be shrinking, the heartbeat
was 165, and I had no bleeding or spotting, which was good
news. My doctor told me that I wasn't "out of the woods"
but my chances for miscarrying were lower since I made it
to the second trimester. My next appointment was at 16 weeks
and there was no heartbeat. The ultrasound confirmed that the baby
had died. I had a D&C performed because of a missed miscarriage.
Could the miscarriage still have been related to the hematoma?
Dear Christie: It sounds like you had a horrible time
in your attempts to have a baby. I was saddened to read
your medical history. Your main question is whether or
not the hematoma you had was the cause of your relatively
me, however, the question should probably be reversed:
what was it that caused you to have a hematoma? You now
have had three consecutive miscarriages. This means that
your chances of their being a specific abnormality causing
your miscarriages--as opposed to random chance being
the cause--are relatively high. You are an ideal candidate
for a recurrent miscarriage work up. The tests involved
in such a work up check to see if your uterus is normal
size and shape, if your hormone levels are normal, if
you have any evidence of infection, and if there is any
specific immunologic problem causing you to miscarry.
I would advise you to discuss with your obstetrician being
tested in this way. If a specific factor is found to be
the cause of your miscarriages, it can be corrected. This
will of course increase your chances of having a successful
Can you tell me if smoking has any cause in miscarriages?
I have so many friends that believe it has a lot to do with
it. Thank you.
Yes, Nikki, smoking does increase the risk of miscarriage.
This has been well shown in multiple studies. The reasons
for this are probably twofold. The first is that levels
of nicotine and other noxious chemicals in your bloodstream
resulting from smoking cause the microscopic blood vessels
in the placenta to go into spasm. This decreases blood
flow to the fetus. Secondly, smokers have a lower level
of oxygen in their blood. The decrease in the amount of
oxygen getting to the fetus increases the chances that
a miscarriage will occur.
I have endometriosis and Graves disease. I understand that
with endo, my risks of miscarriage are higher. But what about
with Graves? My thyroid has been ablated by radioactive iodine
and is now being replaced by synthroid. Is there still a chance
of a problem? Also, with endometriosis, what causes the miscarriage?
Is there a problem with my uterine lining?
Dear Holly: You mentioned that you have two problems, endometriosis
and Graves disease. Contrary to what you have been told,
it is not in fact the case that endometriosis increases
the risk of miscarriage. Endometriosis affects the lining
tissues of the pelvis. It has nothing at all to do with
the inside of the uterus. It therefore has no effect on
the growth and development of the early fetus. Graves disease,
on the other hand, is a condition of the thyroid gland which
can alter the amount of hormone the gland produces. Low
thyroid levels probably increase the risk of miscarriage
and certainly increase the risk of mental retardation in
the fetus. High levels of thyroid hormone can cause significant
health problems to a pregnant woman. Therefore of the two
problems you mention it is the Graves disease I would be
concerned about. Please ask your obstetrician about this.
Following my miscarriage last June I have found that my PMS
symptoms are more pronounced and begin shortly after ovulation
and continue until my period starts again, particularly breast
pain. I have also had excessive acne, more than I remember
experiencing during puberty. Is this normal?
Dear Anya: You asked whether or not your increase in PMS
symptoms, breast pain, and excessive acne following your
miscarriage are somehow related to it. Since women often
experience changes in how their cycle related hormone levels
make them feel, I do not find the changes that you are undergoing
unusual. However several of the symptoms you mentioned are
seen in a condition called polycystic ovarian syndrome.
In this condition the ovary produces an excess of male hormone
and throws off the normal ovulation cycle. So rather than
your miscarriage having caused your periods to change, it
may be that what is currently changing the nature of your
cycles had something to do with your having a miscarriage
the last time you were pregnant. Please bring your symptoms
to the attention of your obstetrician-gynecologist and ask
about the possibility of your having polycystic ovarian
I experienced a missed miscarriage in December of 2002 at
12 weeks. We saw the heartbeat at my initial appointment at
8 weeks. At the time, I was having some difficulty controlling
my fasting blood sugars. I had Gestational Diabetes with my
daughter, so I was tested early with this last pregnancy.
I was started on 10 units of NPH at 11 weeks. My fasting levels
were not extraordinarily high--usually around 110 -120ish.
Could this have contributed to the miscarriage? I am a bit
baffled since we did see the heartbeat at 8 weeks, but then
the baby did not survive. I know that often there are no answers
as to why a miscarriage happens, but I am hoping to eliminate
this possibility if it is even a factor. Thank you!
Dear Melissa: You noted that you had gestational diabetes
with your last pregnancy and that your blood sugars were
very slightly high at the beginning of this last pregnancy
which miscarried. You are wondering whether or not your
tendency toward diabetes caused the miscarriage. I think
not. Although diabetes does increase the risk of miscarriage,
the time frame in which you miscarried falls directly within
that which occurs in 20 percent of all pregnancies. Since
your blood sugars were in fact not very high, there is no
reason not to think that your miscarriage was one
of the hundreds of thousands of spontaneous random miscarriages
which occur each year in United States. If this is in fact
that case, then your chance of having a successful pregnancy
the next time you conceive is 80 percent.
Hello, Dr. Lerner. I am really glad that you are answering
our questions. I am 33 and have a three-year-old girl. I have
had an early miscarriage at eight weeks October 2002 (I was
32). Last cycle, I got a really early miscarriage. It was
my second cycle trying to conceive after the miscarriage.
I would not have known it had I not seen an implantation dip
and tested positive on HPT 10 dpo because my period came on
time. I am now concerned if the two miscarriages have the
same cause and if my age or my husband's age (38) has to do
with it. Does this increase my chances of another miscarriage
or conception? Thanks.
Dear Hope: It appears that you have had two early miscarriages
close together. However the fact that you have a normal
three-year-old girl means that you are capable of sustaining
a normal pregnancy. Not knowing from your note of any other
medical problems, it is most likely the case that you have
had the bad luck to have the egg and sperm that combine
to make you pregnant do so abnormally twice in a row. Since
the risk of a miscarriage occurring is 20 percent, the risk
of two miscarriages occurring in a row is 20 percent times
20 percent or four percent. This is not that uncommon. The
fact that you and your husband are 38 years old only very
slightly increases your risk for miscarriage, perhaps to
about 23 to 24 percent per pregnancy. My advice: keep trying!
If you have another miscarriage then it is time for a miscarriage
What is your opinion on the "luteal defect" and it's role
in miscarriage? Some doctors seem to dismiss it, while others
believe it is a true problem. Also, can taking progesterone
"save" a pregnancy? Thank you.
Dear Tara: You asked my opinion about "luteal defect." This
is a wonderful question. I devote most of a chapter to this
subject in my book about miscarriages. It is a controversial
issue in obstetrics. Some infertility experts feel that
certain women cannot make sufficient progesterone after
ovulation to sustain an early pregnancy. Therefore these
specialists supplement these women in early pregnancy with
intramuscular or intravaginal progesterone. Other experts
say that there has never been a study showing that such
supplemental progesterone decreased the risk of miscarriage.
Because of that, and because of not wanting to expose a
pregnant woman to any medication unnecessarily, there is
an entire school of thought in obstetrics which is opposed
to the use of supplemental progesterone. This school feels
that the notion of "luteal defect" is suspect and has never
truly been shown to be related to miscarriages.
Is it true that your chance of miscarriage rises if the egg
implants late in your cycle (after 6-10dpo)? If so, is there
anything you can do to assure early implantation?
Dear Ali: You ask if it is true that the miscarriage rate
rises if an egg implants late in a cycle. Since the time
it takes from fertilization--which takes place in the
middle to outer part of the fallopian tube--until the
fertilized egg gets into the uterus and implants in the
uterine wall is constant, your question might perhaps better
be "does the miscarriage rate rise if fertilization occurs
relatively late after ovulation?" The answer to this is
yes. There also may be a very slight increase in the risk
of birth defects when "late" ovulating eggs are fertilized.
Can this be prevented? Only with great difficulty. One would
have to watch the eggs maturing on ultrasound throughout
the cycle to be able to precisely time intercourse to avoid
this happening. Why then is the miscarriage rate and birth
defect rate not higher than it is? Because the slight increase
in the risk of miscarriage and birth defects in the situation
is very very small. Practically, since most fertilized eggs
do go on to successful pregnancies no matter when in the
cycle they are fertilized, this sort of "micro" timing is
I am just starting to see a reproductive endocrinologist regarding
my two miscarriages. I am 39 and conceived quickly both times
(four months and three months). We are now in our fifth month
of trying since the last miscarriage. I tested borderline positive
for ACA, and I am on baby aspirin, but my RE still thinks
my miscarriages are age-related, not caused by that. I am having
my FSH tested this month, and am scared to get the results!
If I can conceive (I ovulate regularly) even if I have elevated
FSH is there a chance that I can still have a "good egg" in
there and should keep trying?
Dear Kathy: It appears that you have two issues concerning
your trying to conceive and the two miscarriages you have
had. One is the fact that you were 39. The other is that
you tested positive for anticardiolipin antibody.
of your age, the fact that you have had regular periods
and that you have conceived twice recently are both in your
favor. Yes, it is true that the "quality" of your eggs may
not be as high as when you were 25. Still, most eggs in
most women in their late 30s and early 40s are healthy and
will result in normal pregnancies. The FSH test that you
are reluctant to have may in fact be reassuring by showing
that your remaining egg follicles are producing sufficient
of the anticardiolipin antibody testing, it will be important
for you and your reproductive endocrinologist to look at
the results of all of your immunologic tests in order to
determine whether or not there is in fact an immunologic
problem present. If there is, such measures as therapy with
aspirin and other medications can help decrease your risk
of having a miscarriage based on these sorts of problems.
My first pregnancy went fine. But our second and third pregnancies
ended in miscarriage. Since then we have had three normal
pregnancies but, my question is "Is it in the genes?" Is there
something that causes a woman to have a miscarriage that could
be past down from one generation to another? My mother had
a miscarriage her mother also. And all about the same age.
We have three daughters and a son. So are there any facts
that say why this happens or is it just bad luck?
Dear Carrie: The information in your question tells me that
you and your mother and your grandmother have all had miscarriages.
But you have also had four children, and since you are here,
both your mother and your grandmother must also have had
healthy children as well. As I discuss in detail in my book,
miscarriages are extremely common. They occur in one in
five pregnancies. Most women who have had two or more children
have had a miscarriage along the way. Therefore your pregnancy
history and those of your mother and grandmother are not
at all unusual.
ask if the fact that all three of you have had miscarriages
is "in the genes"? Unlikely. If you told me that you and
your mother and your grandmother have all had multiple miscarriages,
then there might be the possibility that there was a hereditary
genetic disorder present. But for women to have one or two
miscarriages mixed in with many normal pregnancies indicates
that it is much more likely that the miscarriages in your
family have been of the "sporadic type" as opposed to be
due to chromosomal abnormalities.
What is the most common cause of miscarriage?
Dear Jennifer: The most common cause of miscarriage is the
accidental, random miscombination of the chromosomes of
the eggs and sperm during fertilization. For fertilization
to occur the chromosomes in the nucleus of both the egg
and the sperm need to combine and pair off into the 23 pairs--46
total chromosomes--that make up every normal human cell.
For the embryo--the combination of an egg and sperm--to
have these 23 pairs of correctly ordered chromosomes, a
complex rearrangement of genetic material must take place
in each fertilization. Miraculously this takes place correctly
80 percent of time--four out of five pregnancies. One
out of five times--20 percent of the time--when
the egg and the sperm merge, chromosomes do not correctly
align. With the new embryo containing abnormal chromosomal
material, the fetus can only develop to a certain point.
It dies and a miscarriage occurs.
I recently miscarried for the first time at 11.4 weeks.
It was a missed abortion; the fetal age was around eight
weeks at the time I had a d&c. After the birth of my daughter,
I was diagnosed as hypothyroid. I have faithfully taken
my medications as prescribed, and had my levels checked
when I found out I was pregnant so my endocrinologist could
monitor my levels more closely during pregnancy.
much impact does hypothyroidism have on maintaining a pregnancy?
I'll also be 37 in two weeks, and I know that is a factor
in the rate of miscarriage. I truly feel as though my clock
is ticking. I guess I just want to know what my chances
are, given my age and my thyroid condition, of carrying
a second child to term.
Dear Maureen: The role of the thyroid gland in causing miscarriage
is controversial. It is known that proper thyroid levels
are important for the neurologic development of the fetus.
Hypothyroidism, if untreated, can sometimes results in fetal
mental retardation. It is also known that abnormal thyroid
levels in pregnancy can affect in health of the mother.
What is not totally clear is whether or not hyper--too
much, or hypo--too little--thyroid increases the
risk of miscarriage.
or not abnormal thyroid levels do increase the risk of miscarriage,
the problem can be obviated by making sure your blood thyroid
levels are normal. With careful follow-up by your endocrinologist
your thyroid condition should have no impact on your ability
to get pregnant, your chances of miscarriage, or your ability
to carry a healthy pregnancy to term.
Two years ago, I experienced a very early term miscarriage--so
early that I thought it was a normal menstrual period, and
did not know I had been pregnant until two weeks after the
event. I continued to get positive pregnancy tests for eight
weeks afterward, but my next period was right on time.
after the miscarriage, my husband and I decided to try "for
real," and I began basal body temp charting. We had no luck
for six months. Then, during my next period, I passed a
large clot of tissue that looked like nothing I have ever
seen before. It was greyish-pink and had a granular appearance.
I got pregnant two weeks later.
for the length of this, but I've been wondering for two
years if I retained the "products" of that ill-fated conception
for six months. (I never had a D&C.) Is this possible, and
could it have impacted my fertility? I hope this makes sense.
Thanks in advance. -Jennifer
Dear Jennifer: I think it is extremely unlikely that tissue
you passed in the past six months after your very early
miscarriage was tissue from that miscarriage. There are
many sorts of tissue that can emerge from the uterus. That
tissue could have been a polyp, a fibroid, or it could have
been what is called an "endometrial cast." An endometrial
cast is when the entire lining tissue of the uterus comes
out all at once during a period as opposed to breaking up
and coming out tissue fragments and blood. I therefore think
it unlikely that this has had anything to do with whether
or not you have gotten pregnant. It is, of course, impossible
for me to say this with absolute certainty. But from your
description, I think what I said is probably the case.
I lost a baby at 21 weeks almost two years ago. I was told
I have an incompetent cervix. I did however, have several
very strong contractions the night before, so the 'silent
cervix' theory doesn't apply in this case. I didn't know
what was happening (first pregnancy, fairly confident all
would be well) but by the time I was flown to the appropriate
hospital it was too late, and I had developed an infection,
they didn't give us very good odds of making it to 24 weeks.
I had also tested + for GBS at nine weeks gestation. Routine
test in Canada, I believe.
my pregnancy, there was a small amount of bacteria present
in each urine sample. Dr. did not believe it was UTI, but
we treated it with antibiotics just in case. I still had
this ??? in my urine after the course of antibiotics. Dr.
kept saying how unusual this was, but not to worry, so I
if this 'mystery infection' as well as the GBS (am also
RH-) could be why I had PROM? How can I make sure this doesn't
happen to me again, if indeed it was infection that caused
this? I just don't accept the incompetent cervix theory,
as there was too much pain involved, I just didn't know
enough to go in and be checked, a mistake I will never make
again. I thought these 'cramps' were just my back muscles
protesting as I have always had a bad back, though I soon
realized they were unlike any other cramps I've ever had,
realized it too late. Thank you for your time.
Dear BJ: I have to disagree with your assessment of what
happened. The fact that you had some pain just before your
21 week miscarriage does not mean that you had preterm labor
as opposed to cervical incompetence. Once an incompetent
cervix, because of its inherent weakness, dilates to a certain
point, delivery becomes inevitable. At that point you will
have pelvic pain. It seems most likely from your description
that you did in fact have an incompetence cervix, your cervix
opened up, you were about to pass the fetus, and the pain
fact that you were positive for beta strep does not mean
that you had an infection. Beta strep is a "carrier state"--not
an infection. B-strep is a normal organism in 10 to 20 percent
of all women. Beta strep carrier state is not treated during
pregnancy because it has been shown that it is almost never
eradicated by doing so. Beta strep carrier state is only
treated in labor to prevent transmission to the fetus. However
if a woman's urine is found to be positive for beta strep,
this is evidence of a urinary tract infection and she will
your history, the key thing in any future pregnancy you
have is for you and your doctor to evaluate whether you
need to have a stitch placed in your cervix in early pregnancy
to prevent the recurrence of what sounds like cervical incompetence.
Wishing you well.
I am 12 weeks along into my third pregnancy. My first was
a live birth and the second ended in D&C at 9 1/2 weeks
because the embryo quit developing around 7 1/2. This pregnancy
I had some of the same "warning signs" I did with my last
pregnancy at the exact same time (sudden loss of symptoms,
light pink to red bleeding, cramping, and severe migraines)
but at 12 weeks I'm still moving forward. When this pregnancy
began to look like a threatened miscarriage, I demanded
my OB put me on Prometrium vag. suppositories although she
thought it wasn't necessary and still doesn't think it's
what has made a difference although I'm convinced that the
progesterone drop they saw when they did a blood test proves
otherwise. I went in 48 hours at week 5 1/2 from 24 to 16.
question to you is, what are your thoughts on progesterone
supplements helping to keep a miscarriage from occurring?
Why is this such a questionable solution for so many doctors
and why haven't tests been done to prove it's worthiness
at saving a pregnancy. The maker of the drug doesn't even
label that as a use. I'm personally convinced that I would
have lost this pregnancy without it, but find it frustrating
to not have professional support of its merit.
Dear Melissa: Your question is a good one and involves an
area of tremendous controversy. I spend most of a chapter
in my book discussing it. The facts are these: there is
no evidence to show, despite multiple studies looking for
it, that women who use progesterone to "support" an early
pregnancy have a lower rate of miscarriage than women who
do not use progesterone. The fact that you had one pregnancy
that miscarried without progesterone and one that is going
forward with progesterone is not, unfortunately, sufficient
evidence that it is progesterone that made the difference.
These results could just as likely have happened by chance.
When large numbers of women have been evaluated looking
at just this question, no difference was found.
not that doctors have not looked to find an answer to this
question. This question has been studied and the answer
appears to be that the use of progesterone does not make
a difference. For further information please refer to my
extensive discussion of this subject in my book.
: I have had two miscarriages, both at 22 weeks. With my
second one I had a cerclage put in but the doctors said
that one of the babies had chiro (they were twins). What
can I do to obtain my all time goal of being a mother? I
also have been diagnosed with PCOS recently. I have very
high insulin levels and have taken medication for it.
Dear Angie: The fact that you had two miscarriages both
around 22 weeks indicates that you most likely have either
cervical incompetence or an ongoing hereditary chromosomal
abnormality. Unfortunately I do not know what you mean by
"chiro." Could you mean "chorioamnionitis" which is an infection
of the fluid around the babies?
fact that you have polycystic ovarian syndrome does also
slightly increase your risk of miscarriage. However, there
are several effective ways of dealing with this problem.
These involve either inducing ovulation with Clomid or eliminating
the cause of polycystic ovarian syndrome--which appears
to be insulin insensitivity--by use of a medicine called
metformin. Both of these medications help overcome the difficulty
ovulating many women with PCO experience.
have two similar questions so we're posting them together:
I am dealing with a lot of stress now that I am pregnant
that is completely unexpected. Can this cause miscarriage?
I have read in many books and articles that stress may play
a part in Miscarriage. Yet my doctor assures me that my
miscarriage is not a result of stress. No tests were ever
done to find a cause, but I was under extreme stress at
the time of mine. My doctor told me that in fact stress
doesn't have anything to do with a miscarriage. How true
Dear Christina and Dannie: There has been much controversy
as to whether or not stress has any effects on pregnancy
or miscarriage. Based on studies of pregnant women during
the two world wars, it appeared that stress in and of itself
did not increase the risk of miscarriage or birth defects.
There was found to be a correlation between extreme stress
and preterm delivery.
research, however, seems to indicate that there are certain
hormones produced by women under extreme stress which may
increase the risk of miscarriage, preterm labor, and other
pregnancy complications. While more knowledge is being obtained
about this relationship, it is important to remember this:
If stress does increase the risk of miscarriage, the rate
at which it does so must be very small or else this association
would have become obvious years ago. Therefore although
the stress you are currently dealing with will likely make
you feel uncomfortable, it is not very likely to have any
significant impact on whether or not you have a miscarriage.
I was 11 1/2 weeks pregnant when I miscarried. The doctors
concluded that it was a blighted ovum (which I understand
means a placenta but no baby ever formed.) If you can hear
a baby's heart beat at six weeks, why did I miscarry at
almost 12? I was feeling pregnant the whole time (except
for the last week). If a baby never formed, wouldn't that
mean I should have miscarried after five to six weeks? Could
it have been something different?
Dear Johanna: Your confusion over the term "blighted ovum"
is understandable. All that "blighted ovum" means is that
a miscarriage has occurred so early that no clearly defined
fetal tissues have yet formed. If a fetal heart was seen
on ultrasound examination at six weeks gestation--it
would have been impossible to "hear" the fetal heart at
this stage--then the term "blighted ovum" does not really
apply to your early miscarriage.
most early miscarriages are caused by chromosomal miscombination,
the resulting defect in the genetic plans for fetal development
can occur any time in the first trimester. Thus whatever
was not normal with your fetus could have caused its death
sometime after the development of the fetal heart. You could
have seen the fetal heart on ultrasound and yet, unfortunately,
the fetus could have had some other major developmental
defect which went on to cause its death and subsequent miscarriage.
My first pregnancy ended in miscarriage at eight weeks.
The attending doctor told me that one out of three pregnancies
end in miscarriage (maybe he thought it would make me feel
better, but it just made me more nervous.) Is that true?
If not, what is the statistics on that? Thank you very much.
Dear Dawn: I think the statistics your doctor quoted you
are slightly off. In fact, one in five pregnancies end in
a miscarriage. For women who are slightly older--35
to 40 years old--the miscarriage rate is probably one
in four, or 25 percent. Only in women who or 42, 43, or
44 years old, would I think the miscarriage rate to be as
high as 33 percent, or one out of three pregnancies.
I got pregnant seven years ago with IVF twins, and needed
progesterone to sustain the pregnancy, and even then the
levels kept dropping even with suppositories. I got pregnant
naturally for the first time in August and then lost the
baby in October, it had died at eight weeks. Should I have
been on progesterone, the levels were never tested would
that have sustained the baby? Should I go on it if I am
ever lucky to conceive naturally again?
Dear Shelli: You have asked a very common and very interesting
question concerning the role of progesterone in pregnancy.
As I have stated in a previous answer, this is an area of
great controversy in obstetrics. The bottom line is that
progesterone supplementation may be necessary when ovulation
is artificially stimulated by infertility medications. However
there is no evidence to show that progesterone supplementation
decreases the risk of miscarriage in spontaneous conceptions.
This is despite multiple studies having looked at this question
over many years.
fact that your spontaneous pregnancy miscarried likely has
nothing to do with what your progesterone levels were or
whether they were checked. Think of it this way: If there
was something so wrong with your pregnancy that the placenta
was not making the correct amount of progesterone, why should
we think that the fetus itself would have been healthy?
When insufficient progesterone is made in a spontaneous
pregnancy there is usually a reason.
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